Virus World

(CNN) - A minor in New York state has reportedly contracted monkeypox -- a first among children in the state and at least the third reported case of the disease among children in the US. The child lives in New York but not in New York City, according to state health department data released last week. The data does not list the child's gender, city of residence nor how the minor became infected.  New York Department of Health spokesperson Monica Pomeroy said she was not able to disclose the minor's age. "In instances where the number of cases is small, patient confidentiality prohibits the Department from disclosing this information," Pomeroy said.  Previously, at least two other children in the US have had cases of monkeypox, according to the US Centers for Disease Control and Prevention. One case involved a California toddler, and the other involved an infant who is not a US resident. The two cases are unrelated and probably the result of household transmission, the CDC said. Public health officials are investigating how the children got infected. Since the monkeypox outbreak began in May, most cases have occurred among men who have sex with men. But anyone can catch the virus through close skin-to-skin contact.  In the case of children, the CDC said, this could include "holding, cuddling, feeding, as well as through shared items such as towels, bedding, cups, and utensils." The CDC said the Jynneos vaccine is being made available for children through special expanded use protocols. The agency has also developed new guidance for health care providers about identifying, treating and preventing monkeypox in children and teens.

CNN Health's Brenda Goodman and Deidre McPhillips contributed to this report.

Parents have hesitated to take children to doctors’ offices, but students will have to meet immunization requirements to attend school in the fall. Reopening schools, pre-K and day care centers safely this fall was always going to be a crucial part of resuming normal life in New York City, and a herculean challenge for the nation’s largest school system. On Wednesday, Mayor Bill de Blasio raised alarms about an unexpected new hurdle: plummeting rates of childhood vaccinations as anxious parents have kept their children home — and away from doctors’ offices.

During the height of the pandemic, from March 23 to May 9, the number of vaccine doses administered to children dropped 63 percent compared with the same time last year, and by 91 percent for children older than 2, according to the city health department. The city is tentatively planning to reopen its 1,800 public schools in September, along with hundreds of day care sites. But children will not be able to start school and relieve their parents of home schooling and child care duties without shots to protect them against illnesses like measles and chickenpox.

In a typical year, about 98 percent of the city’s public school students are fully vaccinated. “The pieces unfortunately start to fit together in a way that should cause parents real concern,” Mr. de Blasio said in his daily news briefing. Unvaccinated children, he said, could be “at greater threat of contracting a disease that could then put them at a greater threat of contracting Covid.” That is especially urgent now, since New York is seeing a rare but alarming trend of children falling ill with what is being called pediatric multisystem inflammatory syndrome, which appears to be related to the coronavirus and can cause serious illness...

Half of the elementary school students in an unvaccinated teacher’s classroom developed COVID-19 after the teacher — infected and symptomatic — worked for 2 days and read to the students while not wearing a mask, according to researchers. The exposures led to a larger outbreak at the California school in May that was associated with the delta variant, with many cases occurring among children not eligible for vaccination, illustrating a continued need for nonpharmaceutical prevention strategies during the pandemic, the researchers wrote in MMWR.  The outbreak location was an elementary school in Marin County, California, which serves 205 students in prekindergarten through eighth grade, with most students unable to receive the vaccine to due age limits. The school was also reported as having 24 staff members, with all but two of the teachers being vaccinated. One of the two unvaccinated teachers, whom the study identifies as the index patient, reported becoming symptomatic on May 19, having attended social events the previous few days without any known COVID-19 exposures. “The teacher continued working during May 17-21, subsequently experiencing cough, subjective fever, and headache,” the researchers wrote. “The school required teachers and students to mask while indoors; interviews with parents of infected students suggested that students’ adherence to masking and distancing guidelines in line with CDC recommendations was high in class. However, the teacher was reportedly unmasked on occasions when reading aloud in class.”

On May 23, the teacher notified the school that they had tested positive for COVID-19 on May 21 and self-isolated until May 30. The study said the teacher did not receive a second COVID-19 test but reported fully recovering during isolation. “The index patient’s students began experiencing symptoms on May 22,” the study said, and 22 of the teacher’s 24 students were tested for COVID-19, with 12 testing positive, including eight who began having symptoms between May 22 and 26. According to the researchers, desks in the classroom were separated by 6 feet and arranged in five rows. The attack rate was higher the closer students sat to the teacher’s desk — eight out of 10 students sitting in the first two rows tested positive vs. three of 14 in the back three rows. On May 26 and June 2, the Marin County Department of Public Health held testing events at the school as part of outbreak control. During these 2 days, 231 people were tested, including 194 of the 205 students, 21 of 24 staff members and teachers, and 16 parents and siblings of students. A total of 18 people tested positive for the delta variant at the time, and five more tested positive later on. The study’s authors said further transmission might have been prevented by high levels of community vaccination — at the time of this outbreak, approximately 72% of eligible individuals in the city where the school is located were fully vaccinated.

“In addition to vaccination of eligible persons, implementation of and strict adherence to multipronged nonpharmaceutical prevention strategies including proper masking, routine testing, ventilation, and staying home while symptomatic are important to ensure safe school instruction,” the study said. With school set to return in the coming weeks in many areas of the country, the CDC is encouraging districts to follow guidelines to decrease transmission.  In a briefing Friday, CDC Director Rochelle Walensky, MD, MPH cited a second MMWR study that demonstrated that schools in Los Angeles County with safety measures in place during the winter peak of the pandemic experienced rates of COVID-19 that were around 3.5 times lower than the rates in the surrounding community. “While symptoms and severe case in children remain less common than in other age groups, we have seen increases in pediatric cases and hospitalizations over the last few weeks, which is likely the result of overall increases in community transmission generally and more specifically the delta variant’s increased transmissibility,” Walensky said. Walensky said schools should implement as many prevention measures as possible simultaneously, such as ensuring that eligible children and adults are vaccinated, that everyone is wearing a mask, and that appropriate ventilation, distancing, cohorting, screening and testing measures are followed.

“This serves to protect our children even if there are inevitable breaches in any single protection layer,” Walensky said.

Study Cited Published in MMWR (August 27, 2021):

http://dx.doi.org/10.15585/mmwr.mm7035e2